​Informed Consent to Use ​Touch​ in Psychotherapy 
         Somatic Experiencing - Touch/Table work – Bodynamic System 
               
        When appropriate, and according to my clinical judgment, with your approval, I will offer to use 
        touch in our work together. I draw from a number of techniques in which I have had training 
        including ​Somatic Experiencing (SE), Touch/Table work (Somatic Resilience and 
        Regulation-SRR))​ and ​The Bodynamic System​. My touch will ​NEVER​ be of a sexual nature, 
        which is unethical and illegal. 
         
        Somatic Experiencing​ is a short-term naturalistic approach aimed at the resolution and 
        healing of ​shock​ trauma developed by Dr. Peter Levine. SE employs awareness of body 
        sensations to help clients "renegotiate" and heal rather than re-live or re-enact trauma. SE's 
        guidance of the bodily "felt sense," allows the highly aroused survival energies to be safely 
        experienced and gradually discharged. ​SE may employ touch in support of the renegotiation 
        process​. SE “titrates” experience (breaks down into small, incremental steps), rather than evokes 
        catharsis - which can overwhelm the regulatory mechanisms of the organism. 
          
        For more information about SE please note the following references: 
        Levine, P. and Frederick, A. (1997). ​Waking the Tiger: Healing Trauma: The Innate Capacity to 
          Transform Overwhelming Experiences.​ Berkeley, CA: North Atlantic Books. 
        Kline, M. and Levine, P. (2007).  ​Trauma Through A Child’s Eyes:  Awakening the Ordinary 
          Miracle of Healing.  ​Berkeley, CA:  North Atlantic Books. 
        For further references and information online about SE go to ​http://www.traumahealing.com 
         
        SE can result in a number of benefits to you, such as relief of traumatic stress symptoms, 
        increased resiliency, and resourcefulness.  Like any other treatment it may also have unintended 
        side effects, such as sleep disturbances, frightening memories, or unfamiliar and uncomfortable 
        body sensations.  Such reactions are not uncommon and can be attended to in the course of our 
        work together. My own education and training in SE includes completion of the three-year 
        training program as well as the certification process. I have also completed additional trainings 
        since my certification in 2006 and consult on a regular basis with experts in the field. 
         
        Touch/Table work​ ​(SRR)​ ​is an offspring of SE and targets ​developmental​ trauma (from 
        pre-conception to 3-5 years old) and its pre-verbal stages. It focuses on the nervous system and 
        the co-regulation between practitioner and client. Once trust and safety have been established for 
        the “young” physiology on the table, all existing trauma can unfold and be processed. SRR 
        rebuilds the original physiological regulatory foundational piece that never existed in the early 
        years. ​Touch comes in support to the younger self, held in trust and safety on the table. 
         
        For more information about Touch/Table work (SRR), please read​: 
        Kain, K. and Terrell, S. (2018) ​Nurturing Resilience: Helping Clients Move Forward from 
        Developmental Trauma​. Berkeley, CA: North Atlantic Books. 
        For further information online go to: ​www.somaticpractice.net​ and ​www.austinattach.com 
         
         
        This modality, like SE, can result in a number of benefits to you, such as relief of traumatic 
        stress symptoms, increased resiliency, and resourcefulness.  Like any other treatment it may also 
        have unintended side effects, such as sleep disturbances, frightening memories, or unfamiliar and 
        uncomfortable body sensations.  Such reactions are not uncommon and can be attended to in the 
        course of our work together. My education in this SE post advanced modality includes 3 modules 
        of SRR trainings (taken twice with Kain and Terrell), four modules of TST (Touch Skills for 
        Therapists with Kain) and continuing education in TEB (Transforming the Experienced Brain 
        with Terrell). I consult on a regular basis with my mentors. 
         
         
        Bodynamics​ is a body-centered developmental psychotherapy model based on the empirical 
        research done over a decade by Lisbeth Marcher and twelve of her Danish colleagues. It 
        describes development from before birth and continues through the teenage years. The model 
        follows seven developmental stages of how our experience as infants and children is encoded in 
        both mind and ​muscles​. Knowing the psychological function of each muscle allows us to use 
        them as a resource in therapy. We can target a specific developmental stage and zero in on the 
        childhood origins of the difficulties we are presently experiencing. By reactivating the 
        age-appropriate resources/​muscles​, we retrieve forgotten inner resources or develop new ones. 
        We address what is troubling or missing in our present lives as we use the body to bring our 
        history right into the therapy room. During our sessions, ​I will offer to touch or to have you 
        activate specific muscles in order to work through the present day challenging issues​.  
         
         
        For more information about Bodynamics please note the following references: 
        Marcher,L. and Fich, S. (2010). ​Body Encyclopedia: A Guide To The Psychological Functions of 
        the Muscular System. ​Berkeley, CA: North Atlantic Books. 
        Macnaughton, I. (2004). ​Body, Breath, and Consciousness: A Somatics Anthology​. Berkeley, 
        CA: North Atlantic Books. 
        For further information online about Bodynamics go to ​http://bodynamicusa.com 
         
        I followed a one-year basic training in Bodynamics in 2014 and participated in extended 
        trainings thereafter.  
         
        It is your responsibility to tell me when you are uncomfortable with any parts of the 
        treatment.  If you have any questions about SE, Touch/Table, Bodynamics or other 
        treatments, please ask and I will do my best to answer your questions in full. You have the 
        right to refuse, decline or terminate treatment at all times, or to refuse touch, 
        SE/Touch/Table/Bodynamics techniques, or any other intervention I may propose or 
        employ without any fear or concern about reprisal. You may request not to be touched at 
        any time during therapy without needing to explain it, if you choose not to, and without 
        fear of punishment.  
         
        I consent to the use of touch in therapy, and will make my concerns and considerations known to 
        my therapist as they arise. I have read the above informed consent, understand, and agree to it. 
        This consent is added to the form “Therapeutic Contract” signed separately.  
         
         
        Signed: _______________________________________   Date: ___________________ 
         
         
         
        Print Name: ___________________________________